NSG 3600 Exam 4 | NSG 3600 Children’s
Health | Questions & Answers with
Rationales 2026/2027 Update
QUESTION 1
A pediatric nurse is caring for a school-age child admitted with acute post-
streptococcal glomerulonephritis (APSGN). Which clinical manifestation is most
characteristic of this condition?
A) Gross hematuria resulting in dark, tea- or cola-colored urine, along with
periorbital edema and hypertension
B) Massive proteinuria exceeding 3.5 grams per 24 hours with severe generalized
anasarca
C) Bright red rectal bleeding accompanied by severe abdominal cramping
D) Projectile non-bilious vomiting and a palpable olive-shaped abdominal mass
Answer: A
Rationale: Acute post-streptococcal glomerulonephritis (APSGN) is an immune-
complex-mediated condition following a group A beta-hemolytic streptococcal
infection. It characteristically presents with the classic triad of gross hematuria
(resulting from red blood cells leaking through damaged glomerular capillary walls
and turning dark or cola-colored in acidic urine), mild-to-moderate
periorbital/facial edema, and hypertension caused by fluid and sodium retention.
QUESTION 2
A nurse is reviewing the laboratory results of a child with nephrotic syndrome.
Which diagnostic finding supports this diagnosis?
A) Massive proteinuria (3+ to 4+ on dipstick), hypoalbuminemia, hyperlipidemia,
and marked edema
B) Isolated microscopic hematuria with normal serum protein and normal lipid
levels
,C) Elevated blood urea nitrogen and serum creatinine with absence of urine
protein
D) Hypoglycemia, ketonuria, and metabolic alkalosis
Answer: A
Rationale: Nephrotic syndrome is characterized by increased permeability of the
glomerular basement membrane, leading to massive urinary loss of protein
(proteinuria). This results in profound hypoalbuminemia, compensatory
hyperlipidemia, and generalized edema (anasarca).
QUESTION 3
A nurse is providing discharge instructions to the parents of a child with nephrotic
syndrome who is currently in remission. Which home monitoring instruction
should the nurse emphasize?
A) Test the child's first-morning urine daily with a dipstick for protein and report
persistent 3+ or 4+ readings.
B) Check the child's blood glucose levels four times daily using a glucometer.
C) Measure urine specific gravity every 2 hours around the clock.
D) Restrict all fluid intake to less than 200 mL per day permanently.
Answer: A
Rationale: Monitoring early morning urine protein daily using dipsticks allows
parents to detect recurrent proteinuria early—often several days before clinical
edema appears—enabling prompt medical intervention for a relapse.
QUESTION 4
A nurse is caring for an infant diagnosed with hypertrophic pyloric stenosis. Which
electrolyte abnormality is expected on metabolic panel review due to prolonged
vomiting?
A) Hypochloremic metabolic alkalosis with hypokalemia
B) Hyperchloremic metabolic acidosis with hyperkalemia
C) Normal electrolyte balance with severe hyperglycemia
,D) Hyponatremic metabolic acidosis
Answer: A
Rationale: Recurrent projectile vomiting depletes gastric hydrochloric acid and
chloride, leading to hypochloremia and metabolic alkalosis. Renal compensation
and fluid shifts also lead to potassium depletion (hypokalemia).
QUESTION 5
A nurse is assessing a toddler with suspected intussusception. Which diagnostic
imaging modality is frequently used to confirm intussusception and perform non-
surgical reduction?
A) Air or hydrostatic (saline) contrast enema under fluoroscopic or ultrasound
guidance
B) Magnetic resonance imaging (MRI) of the abdomen without contrast
C) Upper gastrointestinal barium swallow series
D) Routine flat-plate chest radiography
Answer: A
Rationale: Fluoroscopically or ultrasound-guided air enema or hydrostatic (saline)
enema is both diagnostic and therapeutic for intussusception. The pressure of the
air or fluid safely reduces the telescoped bowel segment in most stable children.
QUESTION 6
A nurse is assessing an infant with Hirschsprung disease. What is the underlying
pathophysiological defect causing functional bowel obstruction?
A) Congenital absence of parasympathetic ganglion cells in the distal colon and
rectum
B) Mechanical twisting of the small bowel around the mesentery (volvulus)
C) Hypertrophy of the circular pyloric muscle fiber layer
D) Immune-mediated destruction of intestinal villi by gluten exposure
Answer: A
, Rationale: Hirschsprung disease is characterized by the absence of enteric
ganglion cells (aganglionosis) in the myenteric and submucosal plexuses of the
distal colon. This results in a lack of normal peristalsis, causing functional
obstruction, fecal accumulation, and megacolon proximal to the aganglionic
segment.
QUESTION 7
A nurse is teaching the parents of a child diagnosed with celiac disease about
hidden sources of gluten in commercial food products. Which additive or
ingredient often contains hidden gluten?
A) Modified food starch, malt flavoring, and stabilizers derived from wheat
B) Pure table salt and baking soda
C) 100% pure maple syrup and organic honey
D) Fresh unrefined olive oil and coconut oil
Answer: A
Rationale: Gluten is widely used as a thickening agent, stabilizer, and flavoring in
processed foods. Parents must read ingredient labels carefully to avoid hidden
gluten in items containing modified food starch, malt, hydrolyzed vegetable
protein, and stabilizers derived from wheat, barley, or rye.
QUESTION 8
A nurse is caring for a school-age child diagnosed with type 1 diabetes mellitus
who is brought to the emergency department in diabetic ketoacidosis (DKA).
Which clinical signs are expected?
A) Hyperglycemia, ketonemia, glycosuria, dehydration, Kussmaul respirations, and
fruity breath odor
B) Hypoglycemia, diaphoresis, tremors, and normal pH
C) Severe hypertension, bradycardia, and bradypnea
D) Generalized edema, massive proteinuria, and hypoalbuminemia
Answer: A
Health | Questions & Answers with
Rationales 2026/2027 Update
QUESTION 1
A pediatric nurse is caring for a school-age child admitted with acute post-
streptococcal glomerulonephritis (APSGN). Which clinical manifestation is most
characteristic of this condition?
A) Gross hematuria resulting in dark, tea- or cola-colored urine, along with
periorbital edema and hypertension
B) Massive proteinuria exceeding 3.5 grams per 24 hours with severe generalized
anasarca
C) Bright red rectal bleeding accompanied by severe abdominal cramping
D) Projectile non-bilious vomiting and a palpable olive-shaped abdominal mass
Answer: A
Rationale: Acute post-streptococcal glomerulonephritis (APSGN) is an immune-
complex-mediated condition following a group A beta-hemolytic streptococcal
infection. It characteristically presents with the classic triad of gross hematuria
(resulting from red blood cells leaking through damaged glomerular capillary walls
and turning dark or cola-colored in acidic urine), mild-to-moderate
periorbital/facial edema, and hypertension caused by fluid and sodium retention.
QUESTION 2
A nurse is reviewing the laboratory results of a child with nephrotic syndrome.
Which diagnostic finding supports this diagnosis?
A) Massive proteinuria (3+ to 4+ on dipstick), hypoalbuminemia, hyperlipidemia,
and marked edema
B) Isolated microscopic hematuria with normal serum protein and normal lipid
levels
,C) Elevated blood urea nitrogen and serum creatinine with absence of urine
protein
D) Hypoglycemia, ketonuria, and metabolic alkalosis
Answer: A
Rationale: Nephrotic syndrome is characterized by increased permeability of the
glomerular basement membrane, leading to massive urinary loss of protein
(proteinuria). This results in profound hypoalbuminemia, compensatory
hyperlipidemia, and generalized edema (anasarca).
QUESTION 3
A nurse is providing discharge instructions to the parents of a child with nephrotic
syndrome who is currently in remission. Which home monitoring instruction
should the nurse emphasize?
A) Test the child's first-morning urine daily with a dipstick for protein and report
persistent 3+ or 4+ readings.
B) Check the child's blood glucose levels four times daily using a glucometer.
C) Measure urine specific gravity every 2 hours around the clock.
D) Restrict all fluid intake to less than 200 mL per day permanently.
Answer: A
Rationale: Monitoring early morning urine protein daily using dipsticks allows
parents to detect recurrent proteinuria early—often several days before clinical
edema appears—enabling prompt medical intervention for a relapse.
QUESTION 4
A nurse is caring for an infant diagnosed with hypertrophic pyloric stenosis. Which
electrolyte abnormality is expected on metabolic panel review due to prolonged
vomiting?
A) Hypochloremic metabolic alkalosis with hypokalemia
B) Hyperchloremic metabolic acidosis with hyperkalemia
C) Normal electrolyte balance with severe hyperglycemia
,D) Hyponatremic metabolic acidosis
Answer: A
Rationale: Recurrent projectile vomiting depletes gastric hydrochloric acid and
chloride, leading to hypochloremia and metabolic alkalosis. Renal compensation
and fluid shifts also lead to potassium depletion (hypokalemia).
QUESTION 5
A nurse is assessing a toddler with suspected intussusception. Which diagnostic
imaging modality is frequently used to confirm intussusception and perform non-
surgical reduction?
A) Air or hydrostatic (saline) contrast enema under fluoroscopic or ultrasound
guidance
B) Magnetic resonance imaging (MRI) of the abdomen without contrast
C) Upper gastrointestinal barium swallow series
D) Routine flat-plate chest radiography
Answer: A
Rationale: Fluoroscopically or ultrasound-guided air enema or hydrostatic (saline)
enema is both diagnostic and therapeutic for intussusception. The pressure of the
air or fluid safely reduces the telescoped bowel segment in most stable children.
QUESTION 6
A nurse is assessing an infant with Hirschsprung disease. What is the underlying
pathophysiological defect causing functional bowel obstruction?
A) Congenital absence of parasympathetic ganglion cells in the distal colon and
rectum
B) Mechanical twisting of the small bowel around the mesentery (volvulus)
C) Hypertrophy of the circular pyloric muscle fiber layer
D) Immune-mediated destruction of intestinal villi by gluten exposure
Answer: A
, Rationale: Hirschsprung disease is characterized by the absence of enteric
ganglion cells (aganglionosis) in the myenteric and submucosal plexuses of the
distal colon. This results in a lack of normal peristalsis, causing functional
obstruction, fecal accumulation, and megacolon proximal to the aganglionic
segment.
QUESTION 7
A nurse is teaching the parents of a child diagnosed with celiac disease about
hidden sources of gluten in commercial food products. Which additive or
ingredient often contains hidden gluten?
A) Modified food starch, malt flavoring, and stabilizers derived from wheat
B) Pure table salt and baking soda
C) 100% pure maple syrup and organic honey
D) Fresh unrefined olive oil and coconut oil
Answer: A
Rationale: Gluten is widely used as a thickening agent, stabilizer, and flavoring in
processed foods. Parents must read ingredient labels carefully to avoid hidden
gluten in items containing modified food starch, malt, hydrolyzed vegetable
protein, and stabilizers derived from wheat, barley, or rye.
QUESTION 8
A nurse is caring for a school-age child diagnosed with type 1 diabetes mellitus
who is brought to the emergency department in diabetic ketoacidosis (DKA).
Which clinical signs are expected?
A) Hyperglycemia, ketonemia, glycosuria, dehydration, Kussmaul respirations, and
fruity breath odor
B) Hypoglycemia, diaphoresis, tremors, and normal pH
C) Severe hypertension, bradycardia, and bradypnea
D) Generalized edema, massive proteinuria, and hypoalbuminemia
Answer: A
